San Diego Region: Is Health Reform the Answer for the Taxed Safety Net?
Kamal Muilenburg, Executive Director, San Diego Business Healthcare Connection
August 2009
Today, the California HealthCare Foundation (CHCF) released reports on six California health care markets: San Diego, Fresno, Los Angeles, Oakland/San Francisco, Riverside/San Bernardino, and Sacramento. San Diego is my community and I have been asked by CHCF to initiate a conversation on this report.
The regional market report delivers a good description of San Diego's large and complex health care community and I applaud the authors' efforts to look at our health care system from diverse perspectives. The report mentions critical issues and short-term survival strategies — changing reimbursement methodologies, developing new collaborative strategies, and building new facilities — that are being employed today. However, the problems and challenges identified in the report, when looked at together, confirm my belief that the only long-term fix is comprehensive health reform — an approach that offers affordable and meaningful coverage for all, adequate reimbursements for providers, and an equitable sharing of costs.
San Diego's safety-net system is the perfect example of why a comprehensive solution is needed. San Diego, for the reasons described in the report, relies on a network of private-sector providers — community health centers, hospitals, and physicians — that work collaboratively to serve the growing numbers of under and uninsured residents. The report calls our safety net fragmented, which it is in some respects. But it is also very organized and cohesive. A committed and responsible provider community works closely together to make the most of an underfunded system; they work to streamline, improve, and maximize quality and efficiency by sharing resources, information, and funding. In addition to the efforts led by the Community Health Improvement Partners, and the expansion of connectivity between hospital emergency rooms and community health centers, the San Diego County Medical Society Foundation is engaged in a collaborative effort to bring more specialty services to the underserved.
But our safety net is fragile; it is "on the bubble" and just a little more pressure on the system could cause it to burst. There are rumors about which hospital may be on the verge of closing because it just can't afford to keep the doors open, and community health centers are seeing higher percentages of newly uninsured patients, as the current recession drives up the unemployment rate.
In San Diego and elsewhere, providers also face reductions in public health coverage programs for the underserved at a time when they are needed desperately, and cuts to already inadequate Medi-Cal reimbursements. In the commercial market, health insurance companies remain under pressure to offer more affordable premiums to employers, so the trend has been towards leaner health benefits, increased out-of-pocket expenses for consumers and limits on provider reimbursements. The opportunities to cost shift are rapidly evaporating and leaving everyone in a Catch-22!
Given all of these issues and the fragility of San Diego's safety net, what features of a national health reform proposal and/or local approaches would put care for San Diego's low-income residents on a secure footing for the long term?
— Posted 7-20-09 at 12:25 PM PACIFIC by
Kamal Muilenburg
Kamal Muilenburg has worked in health care for the underserved for more than 25 years in San Diego. She is the executive director of the San Diego Business Healthcare Connection and executive director of San Diegans for Healthcare Coverage. The two linked San Diego nonprofits are committed to health care reform advocacy and access to care for all, and helping businesses find solutions to their health coverage needs. Muilenberg holds an MBA from San Diego State University.